Fecal incontinence can be defined as the inability to defer or hold on to bowel movements. The severity of incontinence can range from occasional accidental passage loose stool, up to complete loss of control of solid stool. Problems with fecal incontinence are common and can be devastating to the affected patient.
There are many possible causes of incontinence, although the most common are damage to the anal muscle (sphincter) or its nerves with childbirth, and tissue weakening with aging. For both anatomic and hormonal reasons, fecal incontinence is much more common in women, although it does occur in men.
Fecal incontinence is more common in patients with loose stools or diarrhea. Severe constipation can also cause incontinence when liquid stool seeps past the impacted solid stool. Correction of underlying constipation and diarrhea is often all that is needed to stop episodes of fecal incontinence. Bulk fiber supplements and anti-diarrheal medicines can often be used to make bowel movements more regular and prevent accidents. Decreasing daily water intake may also help, if fluid intake is excessive.
Other anorectal conditions such as rectal prolapse and enlarged prolapsing hemorrhoids may cause fecal leakage and incontinence. Evaluation and treatment of these conditions may eliminate problems with incontinence.
What if the muscle has been damaged by childbirth or injury?
Injury to the anal sphincter is a common cause of incontinence in women who have given birth vaginally. These injuries may not heal properly, although often do not cause problems until later in life. Patients who have incontinence secondary to a damaged muscle are often candidates to surgically repair the damaged sphincter.
A complete history and physical examination will give the doctor clues as to the likely cause of the fecal incontinence. Additional studies to examine the anal muscle, the rectum, and the pelvic nerves will then be ordered as necessary. Further studies may include anal ultrasound, videodefecography, anorectal manometry and pudendal nervetesting.
The primary cause - diarrhea / constipation
Patients in whom diarrhea and/or constipation is the primary cause of their incontinence will be treated with bulk fiber supplements, dietary changes, and anti-diarrheal medicine. If the anal sphincter is weak, but not actually damaged, a course of pelvic muscle exercise and biofeedback may be helpful.
For a gastrointestinal problem
Some patients with fecal incontinence actually have a gastrointestinal problem such as inflammatory bowel disease, or a serious intestinal infection. In these patients, diagnosis and treatment of the underlying problem may correct the incontinence.
Patients who are found to have an injury to the anal muscle may be candidates for repair of the sphincter surgically. If the remaining muscle is healthy, and the pelvic nerves are functioning normally, good success can be anticipated by direct repair of the damaged sphincter. In those patients who have very badly damaged sphincter muscles, or little healthy tissue remaining around the anus, more complex operations may be needed. Possible treatment options include replacement of the anal sphincter with a muscle from the leg, with an artificial implantable sphincter, or stimulation of the pelvic nerves with an implantable device.
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